Dear Dr. Roach: What effect, if any, does alcohol consumption have on swelling in the legs, ankles and feet? I drink only when I go out for dinner or have guests, typically a cocktail and a glass of wine; no swelling in those instances. However, I noticed that after a few days on vacation, when I drank more than two glasses of wine every night, my lower legs, ankles and feet began to swell. Once I returned home and resumed no daily alcohol consumption, the swelling abated. So, is there a connection?
The physiology of alcohol is complex, with potentially adverse effects on the heart, the liver and on secretion of anti-diuretic hormone. All of these can effect swelling. However, it is entirely possible, and probably more likely, that it is a combination of travel and increased sodium intake that is responsible for your most recent swelling.
Even in healthy young volunteers, alcohol immediately reduces the ability of the heart to squeeze out blood. Usually the heart returns to normal after the alcohol is metabolized, but in some people, the heart dilates over time, resulting in heart failure (swelling in the feet has many causes, but heart failure is one of the biggest concerns). In the liver, longstanding alcohol use affects the liver’s ability to synthesize proteins. Reduced levels of the blood protein albumin also might cause leg swelling. Both heart and liver effects are very mild except in people who already have disease of these organs.
The role of vasopressin, also called anti-diuretic hormone, is complex. Initial inhibition of ADH leads to an increase in urine production, then an increased level of the hormone, which can lead to water and salt retention and swelling.
Even though there are at least three ways alcohol can lead to or worsen edema, it is likely that it’s simply swelling from sitting and standing too much, which commonly occurs in travel, combined with a greater sodium intake from eating out at restaurants. Sodium content at many restaurants is much higher than if you prepare your own food.
Dear Dr. Roach: I would like your opinion, as a noninterested party, on laser therapy. I see many ads touting its advantages and success in treating bone-on-bone knee osteoarthritis.
My orthopedic doctor recommended knee replacements on both my knees. I had arthroscopic surgery on the left knee four years ago and was recommended total knee replacement on the right knee about three years ago. How long can I put off surgery, and what is the outlook if I don’t have it done?
I am an 80-year-old female in good health, except for the osteoarthritis. I use naproxen when needed. If it works, I think laser therapy would be less pain and downtime.
Low-level laser therapy has been studied in people with osteoarthritis, and some of the studies have shown reductions in pain and stiffness. The laser is thought to have an effect on circulation. However, the laser generally has been effective in people with mild to moderate disease, and bone-on-bone is severe. I think laser may help some people, but some of the benefit probably is due to placebo effect.
As far as putting off your knee replacements, I have been through this many times with my own patients. Some get it done right away; others avoid surgery until they can’t take it any longer, with worsening pain, stiffness and inability to exercise. Most people have told me that they wish they had done the surgery sooner.